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http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Foreword.2.aspx
No abstract available]]>Mon, 23 Apr 2012 11:45:17 GMT-05:0000003081-201203000-00002http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Ovarian_Cancer___Etiology,_Risk_Factors,_and.3.aspx
Little is known regarding the early aspects of ovarian carcinogenesis. As a consequence, the identification of women at risk for the disease is based primarily on clinical grounds, with family history being the most important risk factor. In this review, we will discuss the various hypotheses regarding ovarian etiology and pathogenesis. In addition, we will discuss the epidemiology of ovarian cancer, including hereditary, reproductive, hormonal, inflammatory, dietary, surgical, and geographic factors that influence ovarian cancer risk.]]>Mon, 23 Apr 2012 11:45:36 GMT-05:0000003081-201203000-00003http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/The_Oviduct_and_Ovarian_Cancer___Causality,.4.aspx
A novel origin for pelvic serous cancer (ovarian cancer) has been proposed in the distal oviduct. This has important implications, including both early detection in high-risk women and wisdom of relying on serological tests to detect a disease that begins so close to the peritoneal surfaces. With the recent discovery of premalignant disturbances in gene function in the tubal mucosa, the concept of targeted prevention is emerging whereby the interruption of a portion of the carcinogenic pathway will prevent cancer. This alternative to detect early malignancy is a new paradigm in the quest to prevent this deadly disease.]]>Mon, 23 Apr 2012 11:45:59 GMT-05:0000003081-201203000-00004http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Symptoms_Associated_With_Ovarian_Cancer.5.aspx
Over the past decade there has been considerable evidence that women with ovarian cancer do have recognizable symptoms before diagnosis. The most common symptoms associated with ovarian cancer are abdominal bloating, increased abdominal size, pelvic pain, abdominal pain, feeling full quickly, and difficulty eating. Some studies also suggest that urinary symptoms are frequently present. When these symptoms occur more than 12 times per month and are of new onset, then ovarian cancer should be considered as a possibility. It is important for women and practitioners to be aware that ovarian cancer is not a “silent disease.”]]>Mon, 23 Apr 2012 11:46:38 GMT-05:0000003081-201203000-00005http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Ovarian_Cancer_Screening.6.aspx
Annual screening of asymptomatic postmenopausal women using a combination of transvaginal sonography and serum Ca-125 has been evaluated in 4 major clinical trials as a means to facilitate earlier detection of ovarian cancer. In several trials, screening has caused a decrease in stage at detection. These ovarian cancer screening trials are reviewed. The effect of screening on ovarian cancer mortality varies in different trials and is the subject of further investigation.]]>Mon, 23 Apr 2012 11:46:57 GMT-05:0000003081-201203000-00006http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Risk_of_Malignancy_in_Sonographically_Confirmed.7.aspx
Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.]]>Mon, 23 Apr 2012 11:47:13 GMT-05:0000003081-201203000-00007http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Treatment_of_Ovarian_Cancer_in_Young_Women.8.aspx
Ovarian cancer accounts for approximately 22,000 cases annually in the United States. Although the vast majority of ovarian cancers occur in postmenopausal women and are of advanced stage, a significant subset occurs in young women. Among those subtypes having a predisposition for young women are malignant ovarian germ cell tumors, sex cord-stromal ovarian tumors, and tumors of low malignant potential. However, invasive epithelial ovarian cancers may also occur in young women, particularly the subtypes of low-grade serous carcinoma and mucinous carcinoma. This article details the diagnosis and optimal treatment of ovarian cancers subtypes in young women.]]>Mon, 23 Apr 2012 11:47:36 GMT-05:0000003081-201203000-00008http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Surgical_Management_of_Epithelial_Ovarian_Cancer.9.aspx
Ovarian cancer affects approximately 21,880 women and accounts for over 13,000 deaths annually in the United States. Although survival rates have improved over the past several decades, directly as a result of advances in chemotherapy and surgery, ovarian cancer continues to have high mortality rates. Understanding the multiple roles of surgery throughout the disease course is the focus of this review.]]>Mon, 23 Apr 2012 11:48:06 GMT-05:0000003081-201203000-00009http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/First_line_Chemotherapy_in_Epithelial_Ovarian.10.aspx
Advanced-stage epithelial ovarian cancer remains a highly lethal malignancy, despite effective cytoreductive surgery and primary chemotherapy. Phase III studies have evaluated multidrug combinations, dose-dense weekly scheduling, intraperitoneal delivery, neoadjuvant chemotherapy, maintenance therapy, and targeting of angiogenesis. Incremental gains in median progression-free or overall survival have been achieved, but without an impact on overall mortality. Data support intraperitoneal cisplatin, dose-dense weekly paclitaxel, or neoadjuvant chemotherapy with interval cytoreduction in appropriate patients. Encouraging data have emerged using antiangiogenic agents, but with questions regarding optimal timing and patient selection. The use of 3-drug combinations or maintenance chemotherapy is not supported.]]>Mon, 23 Apr 2012 11:48:27 GMT-05:0000003081-201203000-00010http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/A_Rational_Approach_to_the_Management_of_Recurrent.11.aspx
Evidence supports the current paradigm for the management of patients with recurrent or persistent ovarian carcinoma. The paradigm requires that patients be classified as platinum-sensitive or platinum-resistant. Patients who achieve a complete response with platinum-based therapy and experience at least 6 months free from recurrence should be categorized as having chemosensitive disease and should be retreated with carboplatin-based doublets. Patients who progress while receiving treatment, whose best response is stable disease, or who experience a complete response of <6 months duration should be categorized as having chemoresistant disease and should be treated with a nonplatinum single agent.]]>Mon, 23 Apr 2012 11:48:55 GMT-05:0000003081-201203000-00011http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Evolution_of_the_Gynecologic_Oncology_Group.12.aspx
This chapter reviews some of the sentinel Gynecologic Oncology Group (GOG) ovarian trials, describes their rationale, provides summary tables for reference, and is organized into early ovarian cancer (GOG 1, 7601, 7602, 95, 157, 175, 212), advanced ovarian cancer optimal (2, 25, 52, 104, 114, 158, 172, 182, 178, 212, 252), and suboptimal disease (3, 22, 47, 97, 111, 162, 182, 218, 252, 262).]]>Mon, 23 Apr 2012 11:49:21 GMT-05:0000003081-201203000-00012http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Molecular_Genetic_Therapies_in_Ovarian_Cancer__.13.aspx
Ovarian cancer is the most lethal gynecologic cancer. Traditional therapies have included surgical management and cytotoxic chemotherapy; however, treatment paradigms continue to shift from empiric cytotoxic chemotherapy to more individualized treatment. Recent research efforts have focused on determining and targeting the molecular biological mechanisms of ovarian cancer in an attempt to develop novel therapeutic modalities with the ultimate goal of improving outcome while limiting toxicity. This chapter reviews progress in the development of novel therapies directed at major pathways implicated in ovarian tumorigenesis including angiogenesis, PARP inhibition, signal transduction, antifolate therapies, death receptor-mediated therapies, histone deacetylase inhibition, immunotherapeutics, and oncolytics.]]>Mon, 23 Apr 2012 11:49:42 GMT-05:0000003081-201203000-00013http://journals.lww.com/clinicalobgyn/Fulltext/2012/03000/Palliative_and_End_of_Life_Care_for_Patients_With.14.aspx
Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. Interdisciplinary assessment and shared decision making are important components. Throughout the disease course, aggressive symptom management can improve patients’ quality of life and their ability to tolerate and continue treatment. End-of-life care focuses on comfort, control, meaning, and support that become particularly intense when death is imminent.]]>Mon, 23 Apr 2012 11:50:05 GMT-05:0000003081-201203000-00014